Monday, March 26, 2012

Living with Lobster Face (aka Battling Rosacea)

One of the first signs of sun damaged skin might not be what you'd expect, especially if you are of Northern European descent. That's my heritage. As a child, I had the "English Rose" complexion with milky white skin and pink cheeks. In the summer, I would get a smattering of freckles across the bridge of my nose that faded long before Halloween. The rest of my sun-tanned skin faded just as quickly, and by Christmas my face and body once again looked the underbelly of a deep-sea, salt-water fish.

When I was a child and young adult, the only concern about sun exposure was to avoid a sunburn because sunburns hurt. We did not yet know that each burn would aggregate the damage that many of us would start to see in our 30s. Plus, it was kind of fun to peel off the epidermal layers from healing skin days after a burn. I admit it.

What we did have back then was suntan lotion, with the subliminal message that if you applied this goo to your body, you'd look like the Bain de Soleil model. The following Mademoiselle ad from 1961 was a bit before I was born, but Sea & Ski was the suntan lotion my family used. I wonder what the SPF was in that little green bottle. I do remember that it smelled heavenly.

I have always been very active outdoors, so my skin soaked up a lot of sun. I also had my share of sunburns—some so bad they blistered, yes, even on my face. Ever get a cold sore after a sun-drenched weekend? I did. Cold sores (aka fever blisters) are a virus, so having one crop up on my lower lip was my immune system telling me to please back off.

There weren't as many options for sun protection in the 70s/80s as we have today, other than Sea & Ski, Coppertone, zinc oxide (what lifeguards wore on their noses), or putting on a tee shirt. I had no idea then that spending my summer days on the lake or beach or sailing from Wentworth to Boothbay would come back to bite me.

By now, we all know that prolonged exposure to sun prematurely ages the skin. When the sun's ultraviolet rays hit the dermis, they prompt the cells to produce pigment, which some of us will see as a tan, but which, with chronic exposure over the years, can create brown spots (they no longer look as cute as freckles) that do not fade in winter the way our tans used to.

The condition of the woman's face below at left is similar to what I saw in the mirror in my late 30s, though her skin appears to be slightly more sun damaged. What is truly telling is the underlying damage to the skin when seen through a black light (aka ultraviolet light, or Wood's lamp) in the photo at right.

The following image shows a more extreme case of sun-damaged skin. If you grew up near the ocean, you almost certainly saw older women (and men), just like the lady below, who appeared on the beach, impossibly tanned, as early as Memorial Day.

Years before I noticed changes in my skin pigment, I noticed a silver-dollar sized cluster of red splotches in the middle of my chest, which on closer inspection appeared to be tiny, extremely-thin, red veins. I went to a dermatologist who pronounced, "Sun damage." That's ridiculous, I thought. It looked more like a rash or broken blood vessels from an injury. He then said, "I can permanently remove those veins ... and also get that vein near your left nostril, as well." He bought out a giant magnifying mirror and showed me a vein the width of a silk thread, which only an atomic force microscope would see, but I said yes. Nuke 'em.

I learned years later that I had undergone my first laser treatment, which was probably KTP or diode or Nd:YAG laser, all of which doctors used to treat single, large, visible blood vessels. The laser came out of a device that looked like a pen attached to a metallic, folding arm, which he wielded like a dentist drill, and oh, did it hurt! I can be quite stoic when it comes to painful treatments—I've even removed deeply-embedded glass from my own foot—but some advance knowledge would have prepared me for what felt like someone snapping my skin with a slingshot.

The next morning, the affected skin scabbed over, but it wasn't anything that kept me hiding at home. In a couple weeks, the red splotches and barely-visible veins were, indeed, gone, but because I was still an outdoors person, and because I did not believe that the visible veins could have been caused by the sun, they came back. And guess what. They brought some friends.

Disappointed, I assumed the dermatologist had lied about the procedure being permanent, and so I lived with an increasing family of teensy veins near my nose and on my chest for another several years. During that time, a miniscule, slightly-raised red spot appeared under my right eye, but I forced myself to get used to that, as well.

Traveling back to my mid-to-late 20s, another change I noticed was that the intense flush I would get from vigorous exercise, cold winds, alcohol (especially red wine and beer), and even sex took longer to fade than it had previously. Now, more than a decade later, I realize that the dermatologist had been partly right when he said that the redness was caused by the sun. Aside from creating hyperpigmentation, ultraviolet rays also break down the blood vessels under the skin and can cause red blotches that fade very slowly or, for some of us, not fade at all. There was an underlying, chronic condition that would eventually get worse over time that had to do with my own DNA and my lifestyle.

Do you blush? I have always been a blusher. You know how some people turn pale when they feel embarrassed or upset? Or their face doesn't change at all when they are having a good belly laugh? That's not me. I turn red. Furiously, neon, beet purple-red. My eyes water and redden, and even my ear lobes turn red. At time marched on, I observed that when I blushed, my skin didn't return to its normal fair state as quickly as it had previously—even when the blush wasn't a blush brought on by extreme external conditions, like cold, heat, or exercise. Sometimes a blush was just a blush, seemingly out of nowhere, but it could burn and last more than an hour, and my cheeks and chin and ear lobes would actually feel warm to the touch. Sometimes a more earnest flush was accompanied by a sensation of stinging or burning, and my eyes would feel swollen, though they did not appear that way.

One day, as I was sitting at my dressing table, I noticed that if I pulled the skin taut across my chin, I could see a cluster of veins on the surface. What I had thought was pink skin was actually caused by the vascular system underneath, veins that had risen to the surface and stayed there. Looking more closely, I saw that the same veins were present on both apples of my cheeks, but my chin had both red and blue in it. I'd been using Prescriptives custom-blended powder to even out my skin tone for many years, but it was no longer concealing the redness, not past the first hour. Panic and vanity prompted my mission to find a more effective, concealing foundation, a quest that was moderately successful, at least for a time. Meanwhile, I wanted to know why my face stayed red all the time, sometimes just pinkish and other times really really red. The catalyst that drove me to seek medical treatment was after a colleague commented on the sunburn I'd gotten over the weekend—except I hadn't been out in the sun at all. I called my primary care physician that afternoon.

Diagnosis: Rosacea!
My doctor told me I had Rosacea, a condition I had never heard of before. She sent me home with some pamphlets and a prescription for Metrogel, which is a topical antibiotic that was supposed to clear up the skin and help calm the redness. I didn't have anything that needed clearing up (I've never had acne), but I was hoping the gel would remove the visible veins.

Rosacea is the visible result of swelling of the blood vessels just beneath the skin's surface. It is not harmful, but you might feel like harming someone when you wake up day after day with a face that looks scorched. Even the National Rosacea Society has not identified a single cause, probably because there isn't one.

What NRS do know is that you are more likely to have or develop Rosacea if you:

are fair-skinned

are female (not as common in men, who can develop the more severe type of rhinophyma, like W.C. Fields)

have a history of excessive alcohol consumption and/or abuse (they aren't called "gin blossoms" for nothing)

are pregnant

have a history of repeated sunburns

are between the ages of 30-50 (I was 34 when diagnosed but noticed signs as early as my late 20s)

DISCLAIMER: Before you read on, please know that I am merely a fairly well-read amateur on this issue. I have no formal medical training. If you think you might have Rosacea, see a qualified dermatologist, preferably someone who is traditionally trained but has a strong interest in integrated medicine. Much of Rosacea can be managed by lifestyle changes (diet)—especially if you don't have permanent redness yet. The sooner you learn how to manage it, the better your skin will look for the rest of your life, and you might even be able to avoid the pharmaceuticals used to treat the condition.

Signs/symptoms: The primary signs of Rosacea are:

Blushing or flushing easily, where the blush lingers longer than it does in other people or than it used to on you

Permanent facial redness, with or without visible spider-like blood vessels, which are called telangiectasia

Acne-like bumps on the skin, called papules and pustules (P&P), which might ooze or crust over

Tightness, burning, or stinging sensations in the face

Irritated, bloodshot, watery eyes (a subtype called ocular rosacea)

A red or bulbous nose (rhinophyma, which is rare)

I read everything I could get my hands on and have concluded that rosacea to be both a lifestyle and vascular condition. You can't escape your heritage, so if you are fair skinned, never ever let your skin burn in the sun. But if you're a blusher (and I can now so easily identify those adorable, blooming-cheeked children who will be at risk for developing Rosacea as adults), there isn't much to be done about it besides knowing your personal triggers and trying to avoid or minimize them.

Test: Diagnosis is not difficult. It simply requires an office visit where the doctor will examine your face and ask you questions about your medical history.

Triggers: It is impossible to avoid all triggers; for example, there's little you can do about walking into an overheated building from the cold outdoors, so we do our best. Triggers can also vary from person to person, but you can minimize some of them and help prevent or reduce the length of flare-ups.

The following are the most common triggers identified by the NRS, combined with some of the triggers I have discovered over the years:

As much as possible, avoid direct sun exposure. Even strong sunlight through a closed window, such as while driving, can cause a flare-up in some people, even in winter.

Use sunscreen every day, though keep in mind that we do need to absorb some sun for its vitamin D. Speak with your healthcare practitioner about managing your risk (like exposing your thighs or butt to the sun, instead of your face).

Experiment with the kind of sunscreen you use. I've found that my skin can handle only the tiniest amounts of chemical sunscreens. Larger amounts irritate (redden) my skin, so I prefer a blend of physical (mineral) and chemical to protect me from both UVA and UVB rays.

Wear a wide-brimmed hat with a strong SPF. Be careful of woven hats, which can still let the sun reach your skin.Visors are OK, but they leave the ears exposed.

Protect your face from cold, strong winds with a scarf, but I noticed that warm breath trapped under the wool can cause my face to overheat and flush.

Don't take super-hot showers and baths; use tepid water. Even when I avoid getting my face wet in a hot-hot shower, I can end up flushed for hours.

Carefully read the ingredients list in skincare and cosmetics products and watch for trends in your skin's reaction; then avoid buying products that contain those ingredients (such as chemical sunscreen, alcohol, menthol, witch hazel, and so on).

For exfoliation (if needed), consider using a gel or lotion that contains beta hydroxy (salicylic) acid. BHA can be less irritating than other acids, such glycolic or lactic acid. Avoid granule exfoliation or Buff-Puff sponges, and be gentle if you use a wash cloth.

If you use tretinoin products, your skin cells will turn over more quickly, which can make skin more sensitive to sun. This is especially true when you first start using Retin-A. Wear a sunscreen that your skin tolerates well, plus a wide-brimmed hat.

Avoid vigorous activity in hot weather, especially under the midday sun. Try to exercise in the early morning or early evening. Alternatively, work out indoors where you can direct the breeze from fan or air conditioner to your face, and drink lots of ice water throughout.

Try to reduce stress. If you don't do yoga or meditate, now might be a good time to start, but be aware that bending poses, with your head parallel to or below your knees, can trigger a flush, so start a yoga practice with upright positions. (Bending over to tie shoes or put on stockings can also bring on a flush—when possible, keep your head over your heart.)

Limit hot spices, alcohol (especially red wine), and hot beverages.

As you pay attention to your triggers, here are some other things you might consider:

Keep a food diary and write down what you eat, so you can more easily spot dietary trends that may cause a flare-up. Some of the most common food triggers are fermented dairy products (yogurt, kefir, sour cream), vinegar, certain fruits (pineapple, avocado), certain vegetables (spinach, mushrooms), nuts and legumes (hard to digest), and any food to which you have an IgE/IgG response, with wheat, milk, corn, soy, fish, and eggs being the most common.

Experiment with controlling your carbohydrate intake and eliminate or limit sugar and flour. This is the single best dietary change I make to keep my skin calm. All carbohydrates raise insulin levels, and a diet chronically high in carbohydrate (which becomes the predominant dietary macronutrient when you drastically lower fat) can lead to systemic inflammation. I know lots of people, including myself, who get immediate, visible relief by limiting carb intake to below 100 gross grams a day and choosing above-ground plants over cereal grains.

Carry a mini portable fan with you, like this one (not affiliated). Maybe even one that disperses a fine mist of water, which you can aim at your face to cool it down ... and also annoy people on the subway!

Sip ice water. I carry an insulated Kleen Kanteen with me at all times. Sometimes I hold an ice cube in my mouth during a heat reaction and pull it out to rub the cube against my skin.

Breathe through your mouth. Although this may sound odd, when I feel my cheeks start to heat up, I'll open my mouth to let the heat out, and take in long, cooling breaths. This method can often avoid a flare up, even if it makes me look like a guppy.

Treatment: There is no known cure for rosacea, only treatment and trigger avoidance. Your dermatologist can help you manage your symptoms with one of the following treatments:

Oral antibiotics (such as the 'cyclines) or topical (such as metronidazole) can help control acne-like skin problems. Note that Rosacea is not acne (though the P&P are referred to as Acne Rosacea) so it won't respond to over-the-counter acne treatments, like benzoyl peroxide or AHAs/BHAs. As far as I know, no one has proved that rosacea is a bacteria, so I prefer to avoid antibiotics, but they do seem to help some sufferers.

Other vitamin A-type medications (such as Accutane or isoretinol) are stronger alternatives to antibiotics. You might also need to experiment to see if your skin can handle tretinoin (Retin-A). My skin loves it, but I started very very slowly, taking almost 6 months to work up to everyday use. When my skin reached max benefits, I dropped Retin-A application to 3 nights a week.

Is it really that important to quickly get a flare-up under control? Yes! It is the chronic blushing and flushing that ultimately leads to permanent redness (telengectasia) as those blood vessels become aggravated, much the same way sitting with your legs crossed can lead to varicose veins.

What I did
After a month on Metrogel, I refused additional antibiotic treatment. The treatment did not reduce redness, and it made my skin feel tight and itchy. Also, because I didn't have acne, I saw little point in using a drug long term that might compromise my immune system.

I lived with the redness as long as I could, using makeup to mask it, until it got to a point where the red shone through anything I put on top, the same way Rudolph's red nose burst through the clay cover meant to hide his shameful glow. I finally decided I'd had enough and consulted my dermatologist, who referred me to a cosmetic dermatologist. This doctor performed laser treatment to get the red out. Was it necessary? No. Did I do it based on vanity? Yes. Did I feel better after? Oh, yes. Would I do it again? In a heartbeat.

I didn't just jump in, though. I had already spent several years reading about Rosacea and trying to manage my symptoms naturally. If you think laser treatment might be for you, educate yourself and be aware of the risks before you go through with any procedure. Even non-invasive procedures that don't require surgery have risks. Make sure you get a referral from someone you trust or research the doctor you are thinking of seeing. The internet has a confusing mix or both real and fake reviews, to be careful.

During my consultation, this new doctor and I discussed the different types of of treatment available, what each procedure targeted (for example, the difference between laser or intense pulsed light therapy for red and brown in skin), what the risks factors were, and what's the worse that could happen. She immediately managed my expectations by telling me that it would require several sessions of IPL to achieve satisfactory results. My skin was that red. She also mentioned that touch-up sessions are often needed every 4-12 months, depending on how well the treatment addressed the underlying condition and whether I maintained a lifestyle that minimized my triggers.

She recommended that I use a combination of Vbeam and IP, and that I could very well maintain my results with IPL a few times a year. She was right. (Update: Going back every 1-2 years is the ideal maintenance interval because I work hard on minimizing/ameliorating flush triggers.)

Vbeam
The Vbeam pulsed dye laser, which is highly specialized for treating Rosacea, produces an intense, single wavelength (burst) of light that selectively destroys the targeted blood vessels without damaging the surrounding skin and tissue. (More on that in a minute.) Vbeam treats vascular skin conditions, such as rosacea, facial and leg veins, psoriasis, scars, red birthmarks (hemangiomas and port wine stains), cherry angiomas, uneven coloring of the neck and chest, red stretch marks, and warts. It can also be moderately skin rejuvenating and smooth over fine lines, but I don't have redness in areas where fine lines form, so I cannot comment on those claims. Vbeam gets the red out IMMEDIATELY.

Though atypical, Vbeam can cause some bruising, but this depends on if you bruise easily and if the machine is initially set too high. An experienced practitioner will quickly correct the setting, but she will start at the highest setting she thinks you can handle (based on her experience with other clients) so you get your money's worth, as you are charged by the number of pulses. You can expect extreme redness immediately after the treatment (which calms down dramatically over a couple hours), and possibly some swelling, which can last a couple days. I experienced all the extremes of redness and bruising, but it was nothing that would have kept me out of the public eye for more than a day. For example, I would not schedule a Vbeam treatment and expect to go back to work the same day, but I showed up for work the day after, applying concealer over the bruises.

Intense Pulsed Light
Unlike Vbeam, which targets specific blood vessels, IPL (also called also called Photoderm, Fotoderm, and Photofacial) is not a laser. It produces a broad spectrum of light that works best on diffuse redness and brown discolorations and goes deeper than Vbeam, which handles only the surface veins. Though my face was almost as red as after Vbeam, the skin was normal within 45 minutes. I could easily schedule an IPL treatment during my lunch break and go back to work with no one the wiser. No down time whatsoever.

Before your first treatment
Here are some tips based on my research, my experience, and tips from the dermatologist:

Plan your first treatment when your skin will be at its most pale. Don't show up tanned. The paler the skin, the more easily the treatment can target the red for Vbeam and both brown and red for IPL.

Consider making a Vbeam appointment on a Friday, so you have the weekend to "recover." It shouldn't take more than a few hours, unless you bruise easily, like I do.

Starting two weeks before your appointment, avoid direct sun exposure. Always wear sunscreen, and if you need to be outside, wear a hat.

Clean up your diet. Avoiding junk food like sugar and white flour can help minimize any potential swelling after the treatment.

Do not drink alcohol or take aspirin before your laser treatment. If you are bruise prone, you should not bruise as deeply if you avoid blood thinners. Also watch how much fish oil you consume in the days before. If you have a headache, take Tylenol.

Bring a wide-brimmed hat to the appointment. Your skin will be extremely sensitive afterward, and you don't want any sun to get on it.

Bring sunscreen to your appointment. The dermatologist might also offer you some. I was given samples of EltaMD® SPF 46 UV Clear through my treatments. I liked it so much I ended up buying it as my daily sunscreen.

Wear absolutely no makeup to your appointment, not even sunscreen. Nothing. If you are coming from work and can't face your colleagues bare faced, you can quickly wash of your makeup with micellar water, such as my favorite by Bioderma.

For IPL treatments, wear a shirt you don't love. Though the doctor will cover you in a paper bib, there could still be a goo mishap.

Ask about taking an oral antifungal, starting the day before your appointment, especially if you have ever had a cold sore before. The doctor will need to write you a prescription, and some may do this as a matter of course. Mine did.

If you bruise easily, consider taking arnica (an OTC supplement), starting 10 days before treatment and right up to the day of the appointment. Continue taking it afterward until bruising heals completely. You can buy arnica at any pharmacy. I let my tablets dissolve bucally for maximum absorption.

During the appointment
Depending on what procedure you choose, your appointment might be similar to or different from what I experienced. Here are some things you might expect:

The person performing the treatment might ask if she can take your "before" picture. I never saw my before-and-afters, but if it goes into the portfolio and helps a prospective customer make a decision, that's fine with me.

Your operator might hand you a warm, wet washcloth and ask you to cleanse your face, even if you went to your appointment barefaced. Do it. You want maximum results.

You'll put a paper cap over your hair (goo protection) and then you will lie down on an examining table.

The operator will cover your eyes with sticky eye patches (don't bother curling your eyelashes that day) and she will spread thick, cold gel on your face for IPL using a wooden tongue depressor. Expect some of the goo to transfer to your hair along the hairline. The goo reminded me of ultrasound gel, and it rinses clean quite easily. (Gel is not used for Vbeam.)

During treatment (both Vbeam and IPL), each pulse will feel like a rubber band snapping against your skin. It is not even remotely pleasant, but it is not teeth-clenching pain, either. On a pain scale of 0-10, I'd give it a 4, but I have a pretty high pain tolerance.

A typical treatment lasts anywhere from 10-30 minutes.

At the end of an IPL treatment, the operator scrapes the gel off your face with the same tongue depressor. Though the operator dropped a blob on my shirt in my third treatment, it came out in the wash. I used a moist washcloth, which the office provided, to get the rest of the stuff off my face and hairline.

Before leaving the treatment room I was given small, frozen blue-ice thingy (technical term) that I gently pressed on my skin during the drive home. At a later appointment, I was given a black tea bag in a cup of ice, and I pressed the teabag on my skin. Unfortunately, the tea water dribbled down my chest while I was driving home. I preferred the frozen gel pack but there are probably other benefits (anti-inflammatory) to using tea. Another reason to wear a shirt you don't love.

After the treatment
Don't be alarmed if your skin looks like your worst sunburn, ever, afterward. My face looked positively scalded after Vbeam (just neon red, no blisters). It looked a bit less red after my IPL treatments, but neither one was immediately pretty.

Recovery is quick, much faster than laser resurfacing or a chemical peel (neither of which I have ever had). By the time I arrived at home, 45 minutes after the Vbeam treatment, my skin had mostly gone back to normal. After IPL, I could have gently dabbed on a little mineral foundation and gone straight to work.

As I mentioned above, I bruise easily, and my skin bruised during both Vbeam treatments, but much less the second time. The doctor immediately saw what was happening and adjusted the machine to a less intense setting. I had a little blue splotch on one cheek and a couple bruise dots on my chin that my concealer mostly covered.

The evening of my first Vbeam treatment (ignoring the wee bruises) I thought my skin looked great! Much of the redness had vanished, and my skin was calm and fair again. Talk about instant gratification. There were still a few veins that didn't get zapped away, but some of them disappeared on their own over the next week. For the ones that didn't, I scheduled a followup appointment a month later. There was some swelling around the bruised areas, but it wasn't bad.

One month after my second Vbeam treatment, I started IPL so we could now target the brown discolorations in my skin. Unlike the immediate improvements from Vbeam, results from IPL are more subtle and occur over time, resulting in a lessening in the brown pigmentation was once freckles. But here's one very important thing: If you expose the treated skin to the sun without sunscreen, the brown pigmentation will come back. So I'd recommend IPL only if you can commit to a rigid sunscreen practice and/or are willing to go back for followup treatments.

My doctor called after every treatment to see how I was feeling. ♥

What does it cost?
These treatments are not cheap, and they are not covered by insurance because they are considered cosmetic. If you are trying to remove a port wine stain, some insurance companies might cover that cost. Cost also varies by region and by practitioner. My first Vbeam treatment cost $750, the second Vbeam cost $500, and each IPL treatment was $350.

What has life been like since
I still love the outdoors, although the six months I went through these treatments, my gardens suffered. And as much as I love a good accessory, I won't hide under a hat full time, so I have mostly given up on IPL. I kind of like my "freckles." But when my redness comes back (and it will because I am a furious blusher), I'll go back for a Vbeam treatment, which was more aggressive and slightly more painful but which gave me the fastest, longest-lasting results.

As for sunscreen, I use different products for different needs. For everyday, incidental exposure, I wear EltaMD UV Clear Broad-Spectrum SPF 46, which is a combination physical/chemical sunscreen. It is cosmetically elegant and works very well under makeup.

Where to get more information
There's a ton of information available on the web about Rosacea prevention, symptoms, management, and treatment. One place to start is the National Resource Society.

UPDATE: Another great resource is a Web site by a dermatologist, Dr. Cleckley, who writes about Rosacea and sunscreen. This noncommercial site also provides excellent information about chemicals and antioxidants in sunscreens, the importance of Vitamin D, and links for further reading. At at a minimum, I strongly recommend you start with the sunscreen selection guide he created for his own patients. (I am not affiliated with Dr. Cleckley or his site.)

56 comments:

Hi, it's me, anonymous again. Thank you for your sharing your experience with Rosacea. Mine started a decade ago and is controlled with daily Metrogel application with only my cheeks noticeably rosy and actually quite pretty unless I drink or get really hot. I had a painful encounter with laser a number of years back, don't remember what type, to remove red veins around my nose but the veins immediately returned. Recently, my right cheek has become much rosier and I am reconsidering laser, given your positive experience and the possibility that newer lasers may work better.Thanks also for your foundation post. I had no success with Laura Mercier mineral foundation as it emphasized large pores (Rosacea's ugly companion), and I disliked the cakey look that the Shiseido sun protection compact foundation created when applied with its sponge applicator. Today I applied the Shiseido foundation with my G527 Hakuhodo brush and to my delight, it looks really nice! Duh, don't why I couldn't think of it myself; maybe that's why I read these blogs. I'm thinking also that I'll check out the few places here that carry Jane Iredale. Have a great day!

Hi, Anon, so Metrogel keeps the red down for you? Hmmm. I never got that benefit from it, so I must be one of the unlucky ones. To be fair, laser does hurt! Maybe I downplayed it because I wanted the red out, and since I waited 10 years to do it, I felt I was worth it. :)

I know what you mean about LM mineral foundation. I love her line, but I was glad I asked for a sample of it at Sephora because it sunk into my pores and created little beige divots all over my face. I'm glad you were able to make Shiseido work with the G527; isn't that an outstanding brush?

I love my Jane but she's not everyone's cup of tea. I guess I love her line the same way some people swoon over Bare Escentuals (sp?), and Alima was too moisturizing for me. Good luck with your JI experiment!

Hi Zuzu, Metrogel has reduced the incidences and intensity of redness for me and I continue to use it to keep my Rosacea from getting worse in the future although I don't really know if it does. My dermatologist also put me on Renova, Skinceuticals CE Ferulic and Retexturing Activator to improve/maintain my aging skin and I've tolerated those well so perhaps my sensitive skin is not extremely sensitive.

I just called Jane and they offered to send 3 samples of the pure pressed foundation in shades that may work. We'll see how that experiment works. I'll get to use the G527 which was retired from service after trying to use it for liquid foundation; I prefer the Hakuhodo G520 or my fingers for liquid.

How interesting that you can tolerate Renova. I experimented with that, regular Retin-A, and Retin-A micro. The micro worked the best because I could spread it more easily and quickly (and my skin is still oily enough). Renova was extremely hard to blend because of the thick cream the treatment is suspended in, and it made my face extremely red, but that was more from rubbing than irritation. I can tolerate the 0.04% fairly well. When I went to the 0.1% my skin about fell off! I was lucky that my dermatologist gave me around 10 sample tubes for each strength. that said, after using tretinoin for many months I didn't see any change in my skin.

I'll look into the Skinceuticals CE Ferulic and Retexturing Activator. It sounds interesting.

That's great news that you'll soon receive some JI samples! I hope you like the finish and wear and can find a good match.

PBI but I love that Skinceuticals CE Ferulic. I first used it to get rid of some pigmentation after being pregnant with Miss L, but now I buy a bottle at the beginning of every summer. It helps to boost the effectiveness of sunscreen too.

Thanks, Grace and Anon! I just added it to my dermstore.com shopping list and will . I wish Sephora sold it--I have a credit there. I like that there are so few ingredients. (Posted here in case anyone else is interested.)

Hi Bella, I was also taken aback by the price! And yes, there are countless ways to manage Rosacea naturally (diet and relaxation are key), but once the red becomes permanent (e.g., the telengegtasia appears on the skin), nothing short of laser will remove it. It's the only proven treatment, and the veins never go away on their own. Sad but true. They also tend to spread and worsen over time, especially for we blushers, so I had the option to endure comments about my "sunburn" for the ages, continue piling on makeup, or get my old skin back (OK not quite, as I was 10+ years older than when I first noticed the veins on my face).

As I get older, I find myself wanting to wear less makeup on my face, and I really disliked covering it with opaque stuff.

I have zero regrets! All told it cost less than many beauty bloggers spend on a weekend at IMATS, so I guess we all have our little luxuries that make us feel good. :)

Thank you SO much for all the details you told about your experience. I'm having this dye laser next thursday and I'm a bit (or a lot) afraid. I have these blood vessels all over my face because of a laser (carbon dioxide) I had 3 months ago and didn't go well. Now I have a lot to fix, and this is one of the issues. Now, because you took the time to write about it in so many details, I know what to expect. It's not good to know about the pain, but now I know it's effective, and that the results are fast! I can't thank you enough. :)

AMAZING amount of info Zuzu! I think I have a tiny bit of Rosacea, but nothing major-yet. I know my mother had it because she had veins on her cheeks. So glad the laser helps you. I still think I want to have laser for some hyperpigmentation though. That sun ad made me laugh. Did you ever coat yourself with iodine and baby oil to tan? I DID. Sigh. Oh the stupidity.

Tracy, I did mix iodine in my baby oil. It was supposed to draw the sun more intensely to you, or something like that—maybe the way some people hold a mirrored board to reflect the sun back on themselves. Craziness!

One day, while at the beach, I spilled a drop of iodine on my white wool blanket (sounds like a weird thing to take to the beach, but the weave kept sand from filtering through and the white was cool). I was moderately upset that I made a stain, but later, when I was shaking out the blanket I felt the sun hit me in the eye, and I saw that where the iodine had spilled there was now a HOLE! That was the end of my iodine experiment.

My pleasure, Odyssey. I hope you find something that suits you in the Jane Iredale line. The Powder Me SPF comes in translucent and tan. I enjoy using dry sunscreen because I can apply it over my makeup. Or if I am makeup free, my face feels smooth, not gooey, which is often the result of a physical sunscreen.

I imagine you have made a lot of people feel much better. I had a bout of rosacea in my 40s, oral antibiotics chased it away. Knock on wood, so far no reappearance. It was very unnerving, and I was so glad to see it go.

How lucky you were able to nip it in the bud, LPC. I wasn't given the option to take oral antiBs, and I didn't learn about lifestyle changes until years after the fact, so I unwittingly made things worse without even knowing it. I could name particular veins for each bottle of red wine I had drunk. ;) I still love the stuff but I rarely drink it because it practically makes my face explode. Instead I cook with it. Pouring a good splash into a hot skillet where I had just cooked a steak makes an awesome sauce!

I'm not the only one allergic to chemical sun screen!! It took me so long to realize that it was the sunblock I was using, not the sun itself, that was turning me bright red. Thanks so much for all this information! I think my graduation present to myself is going to be rosacea treatment hehe. It's so hard to avoid triggers (LOVE me some red wine!), but looking like a tomato half of the time is beyond frustrating. People ask me if I'm "ok" when I work out. I wouldn't wear foundation at all if it weren't for the fact that I know I'm going to red at some point during the day. Maybe it's just me, but I've noticed some correlation between migraines and persistent flushing. Did the metrogel help with the redness or just acne? I don't have much acne currently, thank goodness, just the usual lobster face. Thanks again, it's so nice to know I'm not the only one :)

EmmyJean, I did not get rosacea acne, so the Metrogel didn't do much for me at all. Looking back it might have done a better job at calming the redness if I'd been told to avoid certain things that were causing me to flush still. My original diagnosis came from my primary-care physician, not a dermatologist, so she didn't help educate me. Since it was around 1997 when I was diagnosed, I wasn't yet the avid online researcher that I am today, and even if I had been, there was probably a lot less information about a condition that was not terribly studied back then.

I know what you mean about people asking if you're OK. My mother had rosacea as well (another English rose), and one of her "friends" used to always ask her, "Why is your face so red?" Rude, yes?

I am happy to say that two years after laser treatment, I only wear foundation if I want to. I still get pink around my nose, but I suspect that's an area people with normal skin get pink, as well. I do need a touchup, but it will be minor. Knowing what to avoid helps tremendously!

It would make sense to me that migraines could trigger a flush. Think of the stress your body is under when you are in pain. I don't know how you manage the pain, but perhaps keeping a gel eye mask in the fridge would help. Then when a migraine comes on you could lie down with the cool mask on your face. I've never had a migraine, so I don't even know if it's feasible.

FANTASTIC POST! This is so thoroughly researched, beautifully written, and incredibly informative. This is certain to help many people. Do you mind if I link to it in my blog? I think everyone should read this post!

I was cringing when you were talking about the repeated exposure & cumulative damage from sun burns. I remember climbing on the roof of my house as a teenager and using either baby oil alone, or Bain de Soleil (SPF 8). I suspect that I probably wouldn't have listened to an adult telling me that was a bad idea to bake in the sun if we knew then what we know now!

Aaaaaagh! Rooftop tanning. I had completely forgotten about that. I also remember that orange glop from the Bain de Soleil tube. It was my mother's favorite "tanning lotion," which is what we called sunscreen back then, and she's even more fair than I (natural redhead), so her applying an SPF 8 only was a joke, and she loved the sun. Both my parents ended up having skin cancer (successfully treated), and I have already had one precancerous lesion removed from my forehead. I get a skin scan every year and suspect that, by the time I hit my mid 60s, additional outpatient surgery will be required on my poor, abused skin.

I doubt I'd have listened to an adult, either. Teenagers are omniscient, dontcha know. ;) In fact, I was under the misguided impression that if I didn't actually burn, even moderately, I would not tan. So in my sunbathing episodes, I'd keep pressing my finger into the skin of my thigh. When the white impression left by my finger lasted a couple seconds before it filled back in with pink, I knew it was time to come in. I absolutely shudder when I think about that now and wish I could go back in time and counsel myself!

Thanks, Zuzu! I will definitely post it to my blog-- I just think that the importance of what you have written cannot be understated.

Weren't we just so stupid at that age without even knowing it?! I remember doing the push the skin test as well. I remember peeling sheets of sunburned skin off my shoulders and having those unsightly white peeling edges, but I was more focussed on whether the skin beneath the hot mess was coming in tan. I mean really, what an idiot I was! Thankfully I don't look like an old leather shoe, but that's probably because I was in the Bay Area rather than Southern California at that time-- so those opportunities to bake in the sun were few and far between! I still remember the smell of that orange Bain de Soleil in that metal crimp tube! I remember thinking that was such a luxurious splurge over Sea & Ski (I had forgotten all about that brand) and Coppertone. Plus Bain de Soleil seems like some type of Haute Couture French luxury item (apparently it is part of the Coppertone family- at least it is now).

Hee, I still liked peeling that skin and flinging it at my little brother, or worse, wearing it on my nose and chasing him around the house going, ARRRRRRR. I was an early Hannibal the Cannibal in the making, apparently.

I spent my summers on the New England coast, so we had only around 3 months of real sunbathing. Lucky for me, I guess. Sometimes it shocks me that I am, for the most part, unwrinkled. Maybe if I ever lose this weight, I'll collapse into a prune. It's the fat that keeps me looking juicy. :D

I totally remember the smell of Bain de Soleil, and I thought it was a luxe brand, too. It helped that the model for it was a very chic, French-looking woman. Wasn't it Renee Russo, circa 1977? In my mind, I can see her lying on her side with a bikini and a wide-brimmed hat.

Do you remember the song? "Bain de Soleil for the Saint Tropez tan..." ❖

OMG!!! I totally remember that ad with Rene Russo!!I found it:http://www.pacocamino.com/2010/08/vintage-ad-bain-de-soleil-1977/The You Tube video is hilarious- I completely remembered the song!!

There was undoubtedly something really satisfying about picking the peeling skin- pretty funny that you would chase your brother flinging the peeled skin at him. You didn't keep him in a well while waiting to flay him did you??

3 months of real sunbathing is probably at the upper most level of my exposure-- so lucky for both of us that we don't look like old leather shoes. I could never understand why the leather skinned people like the picture in your post would continually bake themselves-- I wonder if this is a different type of body dysmorphic disorder where perhaps they feel that they are still too fair skinned?

I love reading all of your posts. We share so much in common. I hate my blasted Rosacea. I had 3 IPL treatments a couple years ago without any result. She didn't turn the machine up very high because she feared my skin being overly sensitive because I was so fair. I said I didn't care and I could take the pain I wanted results but nope. Maybe if she'd have cranked her up a little bit I would have got more of a result. I will have to look into a combo treatment as you mentioned. It was hard enough to come up with the money the first time though!

I look forward to keeping my babies fish belly white for their entire childhoods so they don't have to endure some of the things I have.

Peeps, how disappointing to pay all that money and get no results! I do think Vbeam is the more targeted treatment for rosacea, which really is a surface condition, whereas IPL gets the deeper stuff and brown bits. Vbeam is more expensive, to be sure, but it gets the job done in one, maybe two treatments, and the second time you'd need fewer pulses (my doc said # of pulses is how they base the price range), so it would cost less.

It's good that you know as much as you do about sun damage so you can protect your children, unlike our parents who were mostly ignorant. Don't forget that sunlight provides much-needed natural vitamin D, which is necessary for many of our bodily functions and can help ward off diseases, like clinical depression, joint problems, and cancer! As long as those babies don't burn, they should be fine. :)

Thanks for the post, very informative! Judging by the picture, I'm a type 1 rosacea sufferer as well and have some small spider veins, but darn it, I'm not going to forgo a glass or red wine, a nice bowl of Greek yoghurt or sex with my boyfriend (pretty sure he's not into a threesome with me and a fan). I'll take the bit of redness on my cheeks, I have too many other things to worry about. We women can't look perfect all the time (and how many men do you know who do?).

LOL on the threesome comment. You do have a point, and I agree we should live our lives as we feel most comfortable. I admit I did it for the vanity and also so I could go out to restaurants and enjoy a glass of red wine without my face turning into a steaming, streaming little red caboose. Trust me when I say, I've seen hosts and wait staff looking on nervously in the past, probably wondering if I'd choked on something. Zapping away the red gave me a clean slate.

Lucky, lucky, fortunate you, Grace! My bad decisions were based on growing up at the beach with such white skin, when everyone around me was bronzed and golden. Both my mother and I tried to force our skin to be something other than what it was. It didn't help us that my father (black hair and ice blue eyes) tanned like a demon and wanted nothing more than to be on the sailboat.

In just the last couple years, I have also grown to prefer my skin almost bare (though I still like at least a wash of eyeshadow, a smudge of powder eyeliner, and ALWAYS lipstick). I don't mind my flaws; in fact it appears that trying to conceal them only draws attention to them, which was why I had the red removed. Based on the amount of burning my skin endured in my younger years, I am really quite amazed that my skin is not riddled with wrinkles and spots. I guess I inherited at least that DNA from dear old dad, if not his ability to produce melanin.

If a genie could send me back in time, I would still live on the beach (nothing calms my sole more than the ocean), but I'd have been much smarter about my sun exposure and I'd have collected many fabulous hats!

Late to the party, but I wanted to tell you how much I liked this post. As a fellow rosacean, my history of sun exposure and unfortunate dermatologic sequelae are very similar to yours. Great that laser worked for you! I haven't gone down that path yet--probably should. I use Metrogel, Finacea, and Ovace cleanser with decent results. I do Johnson's baby shampoo eyelid washes for ocular rosacea.

Thanks, EmmaPeel. I remember you mentioning you had ocula rosacea, and I wonder if I have it, too. I don't have a "gritty" sensation in my eyes, but they become bloodshot and watery--all I have to do is laugh or yawn. Or breathe. I should be a highly-sought actress who can cry on demand. Or I just look like I "burned one" on the way to work. ;-)

LOL. You might have the start of ocular rosacea. I get bloodshot, watery eyes (especially my left eye). Sometimes it feels like there's an eyelash in my eye when there isn't one. I don't get a gritty sensation. The baby shampoo washes have helped tremendously.

Good to know, thanks! . What's your eye shampoo ritual? Do you pour a drop into a sterile bowl, froth it up, dip a cotton ball into the suds, press against your almost-closed eye, and move your eye around under the lid?

And how often do you do this?

I keep Baby Shampoo around for those rare instances when DH or I gets blepharitis or a stye.

I do my eye shampoo twice a day, morning and night, immediately after washing my face. I use a drop of baby shampoo mixed with about 1/2 - 3/4 inch of warm water in a non-sterile wee plastic cup. I froth it up with my finger and, with my eye completely closed, I dip my finger in the cup and rub the mixture back and forth across my lashes. I rub about 3 times top and bottom for each eye, redipping my finger in the cup a few times as needed. I rub the exact spot where one tightlines if doing it from the top side of the lashes. I hope this makes sense.

I don't know about the laser treatment... I don't think I could do it! But I'm glad to hear it has worked for you! I prefer to stick to my natural treatment, which is luckily really working for me! Metrogel didn't really work for me either! I used to not be able to walk out of the house without make-up. Yeah, it was that bad at times. I had like this huuge bag of every foundation out there, but my favorite brands were estee lauder and clinique. My skin has really improved now though, so I don't have to waste so much money on my expensive foundations! For me, my biggest triggers are spicy foods (sadly!!) and alcohol so I just stay away from them!

Hi Sylvia, it seems so unfair that now that red wine has the stamp of approval, I can't get anywhere near it without an antihistamine taken beforehand and a large glass of ice water to sip in between sips of red.

I am glad your skin has improved. My mother's rosacea seemed to disappear on its own, and she was getting some pretty bad telengectasia. I don't know if they have done long term studies, but I wonder if the blood vessels become reabsorbed when people avoid their triggers for a prolonged period. That would be great news if true.

Hi Zuzu, tell me about it! I used to drink some red wine everyday (no, I wasn't an alcoholic, I just liked the health benefits and the taste of course of it haha) until I was diagnosed. I haven't read any studies about that yet, maybe they have some going on currently? I mean it would seem to make sense. Let's hope! But my skin hasn't just improved and disappeared on its own like your mother (lucky woman!). I am active and exercise regularly and have a healthy, balanced diet :) Some of my friends think I am an over obsessive health freak... I don't know maybe I come across that way to some people? So along with all that I take Res-juventa which has really improved my skin. And it's funny because speaking of red wine, it is made of spanish blue grapes which contain the same antioxidants and stuff as red wine itself! I came across this product when looking for something to replace the benefits of red wine after realizing I can't drink it anymore! So has your skin remained pretty good after the Vbeam IPL treatment? Ahh I still couldn't imagine going through that all! Oh I don't really know because I'm not the biggest fan of yogurt. Is it really bad or kind of like those "mildish" triggers if you know what I mean?

The funny thing is I don't love red wine, but I was starting to develop a taste for it. I do, however, love beer and spirits, but no matter what I drink I get red and HOT! Holy hotflash, catwoman!

Many congrats on your healthy lifestyle! But doesn't the exercise make you flush? I Have never heard of Res-juventa and will look it up after I post this comment. I use Caudalie products which are made from grapes, but I have no idea if they contain the wonderful resveratrol. Maybe it's white grapes, but if feels fantastic on my skin (Vinperfect Radiance Serum). My skin is actually not that sensitive. I can even use Clinique Clarifying Lotion II on it, but chemical sunscreens make my skin want to jump off my face.

My skin is a little more pink than after I finished my treatments, but that's partly because my carb intake is currently too high (deadlines/no time/excuses/yadda). When I get my gross carb intake to 100g and eat at least 25g of fiber, my skin is so calm and clear. None of the old telengectasia came back except for two very fine lines around my nose, but my derm told me those are really hard to beat. I was supposed to go back for maintenance treatments every 3-4 months, and I never went back, so overall I am quite pleased with the results and it was money well spent. And it wasn't that painful at all, but maybe I was just willing to stand anything to get the gin blossoms off!

As for yogurt, it's fairly bad. My entire face gets red, though no one has ever commented and said, "Did you get a sunburn?" I think it's probably more noticeable to me, but my face also feels very hot. I can feel it coming on, starting with my ears, chin, and cheeks. The bummer is if I continue to flush the telengectasia *will* come back, but I guess I could go back for a followup. This isn't a good time of year to go, though. You must stay out of the sun 2 weeks before and 2 weeks after treatment, so I'd be stuck inside for a full month. No thanks. I'll think about going in the dead of winter.

Haha it really sucks! I'm not laughing at the fact that you get red and hot, just the way you wrote it was funny!Thanks it really takes commitment but it sure pays off! Yes, I do have to be careful when I exercise. I do light workouts in increments so that I don't overdo it. Oh yes, I've tried a moisturizer from there but they are quite pricey! I don't know if they contain resveratrol but I have to admit it was a soothing moisturizer! On the Res-juventa box it says 100% all natural resveratrol which we know is the healthy ingredient in red wine.Oh that's great! Yeah those "maintenance treatments" are just extra ways to earn money for them I think. I mean you never returned and you are pleased with it!Wow never thought yogurt could be such a bad trigger! That's usually the case; we think it's worse than other people actually think! I guess you're just going to have to stay away from that yogurt! Spicy foods were the hardest to stay away from for me! But I have learned to cope without it...

Yogurt is one of the worst triggers, I suspect, because it is fermented. Many Rosaceans have similar issues with vinegar and mustards, etc. It's sad because when I don't eat sugar, Greek yogurt with fresh berries and chopped pecans is my ICE CREAM!

Between no dairy, gluten, sugar, booze, and whatever else I am avoiding, I should just eat celery. :P

greetings zuzu - i found your blog this week and have really enjoyed it. i expect we are about the same age and although i have completely different coloring (need warm corally colors to look good) i really appreciated your approach to all things beautiful.

then, i found this article and you can be sure that i will subscribe. i am 47 now, but got the rosacea Dx at 40. like you, i can spot the flushers to be when they are quite young and have both of my teen aged daughters on good skin care regimens. in fact, i have all 3 of us on paula's choice products primarily. i avoid the AHAs, but really do like her BHA products, especially with having rosacea.

i too had a series of IPL treatments and although it helped, i would like to do something more so will look into the Vbeam. my skin is in very good shape for my age, but i have taken good care of it since my teens, but i still have full on 'red alert' days when no amount of foundation/concealer will seem to help and i don't even want to leave the house.

it does sound as if you may have ocular rosacea as well - not really pleasant for those of us who do enjoy serious eyeliner and it can make most mascaras pretty iffy too. i basically need to use a good waterproof mascara year round. i did just find a new product from Anastasia which is a waterproof clear coating designed to go over any mascara and so far, i am liking it.

i am also a huge fan of JI so seeing that among your product stash was particularly delightful (as well as the mercier ones which i LOVE).

Good post! Thanks for sharing this and I am glad the laser and IPL have helped you. My rosacea is too bad and sensitive for them I found, I use anti flushing medication that helps to a degree to keep matters calm: clonidine, propranolol and mirtazapine. You can read more about these medication on scarletnat.blogspot.com

Thanks and good luck for all the rosaceans out there, it is a very nasty condition to have to deal with.

Thank you for your writing and all of the comments. I knew I had rosacea when I was quite young - probably in my late twenties. My cheeks look like my mom's so it was easy to know I was following in her footsteps. I am 42 now and seem to be having quite a flair up these last two months. My face is redder than ever and there are little bumps on my cheeks. I know to avoid alcohol - I rarely drink anyway. I happen to have celiac (diagnosed at 1 year old) and try to avoid gluten. Reading about yoghurt is new - I love the stuff so I will try and cut back. I have never used make up because all of it made me itch my face something terrible. I am going to try and see a skin doctor for the first time ever to see what can be done. My face is so warm and itchy, something has to be done!

I can't believe how much information is provided on this site! I suffer from flare ups and have redness prone skin. I discovered NARDO's NATURAL Organic Skincare and am very impressed with their Rosacea Care Serum. I think my results are from the lack of chemicals found in the products. ex... fragrance free, dye free, paraben free...etc. I am not sure how to tell if I have Rosacea? Since using the product, my redness had decreased and my skin tone is now even. Is there a test to tell if you have Rosacea?

Hi Kayla, as far as I know there is no definitive test--they still don't know for certain what causes it (I don't think there is a single cause), and there is still debate about what kind of disease it is (bacterial versus vacular).

You are prone if you are of Northern European descent and blush easily. I might have said this already, but I don't want to re-read all the comments ... in my 20s, I started to notice that my earlobes would get very red and hot when I drank alcohol, and in my early 30s, I noticed that while at the gym (and surrounded by mirrors), my face would get flushed and it would not become unflushed even though I had stopped the vigorous activity. Facial flushes started to take many minutes to hours to calm down. And then at around age 36, when I noticed what appeared to be permanent redness on my chin. I went to the doctor who told me I had rosacea, and she was right. She prescribed medicine, but I prefer to manage it naturally, and I have been able to do that with diet.

If you think you have rosacea or you're the type who could easily develop it, all I can say is try to avoid triggers that cause the intense flushing. Harder said than done. It would mean not eating spicy food, drinking hot drinks, avoiding exercise and sex ... all the fun stuff.

One thing you can do is eat a controlled carb diet. The high carbs recommended by the Food Pyramid chronically raise insulin levels, which raises cortisol and causes a nasty cascade of other hormonal reactions. The Food Pyramid, BTW, is total BS. We were a much healthier nation/world before the lowfat/high carb craze. But that's a subject for another rant. ;)

Hello,I just read an interesting post on a NY Times blog about a woman who cured her Rosacea with daily application of a baking soda and peroxide mask. I'm going to try this, it couldn't hurt since I don't have the funds to do any other treatment and anti-biotics are so damaging to your digestive tract. Also I've been reading in Chinese medicine that daily glasses of lemon water are said to cool the body and Rosacea tends to occur in people who have an excessive amount of heat in the body. IDK it might be hocus pocus but hey it couldn't hurt, right?

Hi Interesting article. Im a Beauty therapist and for those fine spider veins on the face I use a new method of removal. I do have an IPL but this new method only targets the spider vein and not the surrounding area. A fine probe is used (thinner that a hair) and it is used to lightly touch the skin along the vein. The radio frequency coagulates the blood and collapses the vein. You can watch the vein disapear. Usually one treatment is all thats needed for the face. On the legs 1-2 treatments. Its called Spider Vein Coagulation using RF. You get a cat scratch look to the area but it is gone in a couple of weeks along with those pesky veins.

Hi I am a Beauty therapist and I use a new treatment for spider vein removal on the face. Its call Spider Vein Coagulation using RF. I have an IPL too but this method targets the veins directly and not the surrounding skin. A fine probe (thinner than a hair) is used to touch the top of the vein. The Radio Frequency coagulates the blood and collapses the vein.You watch them disapear! The area looks a little cat scratched after, a bit of redness for 2 weeks but that disapears along with the vein. Usually one treatment on the face and 1-2 on the legs.

Thanks for letting me know about alternatives. RF certainly sounds more targeted. Perversely, I'd love to watch my own veins collapse. V-beam worked great on collapsing the red veins (and has kept my skin clear going on 4 years now), but I have one opportunistic vein that keeps coming back along the outer side of my left nostril.

I assume cost of RF is based on the number of pulses (joules)? At my dermatologist, IPL has a flat rate, and V-beam is based on number of joules, with a minimum starting point (probably based on how many pulses the average person needed), and then rising in three tiers.